Our common interest in surgery of the vertebral artery was born in 1976, when as residents in the same hospital, we attended an attempt by two senior surgeons to treat an aneurysm of the vertebral artery at the C 3 level. Long discussions had preceded this unsuccessful trial, to decide if surgery was indicated and to choose the surgical route. Finally a direct lateral approach was performed, but access was difficult and correct treatment was impossible, resulting in only partial reduction of the aneurysmal pouch. Following this experience, we decided to seek a regular and well defined approach for exposition of the vertebral artery. Review of the literature indicated some surgical attempts, but the descriptions did not give the impression of safety and reproducibility. No landmark on the described surgical route appeared sufficiently reliable. Henry's anatomical work (1917) gave the only accurate description on vertebral artery anatomy, and it became the basis for our work. When the same patient was referred again one year later, after a new stroke in the vertebro-basilar system, we had behind us repetitive experience on cadavers of an original approach to the distal vertebral artery.

Skeletal involvement is a frequent and troublesome complication affecting many patients with neoplastic disease, especially multiple myeloma and cancer of the breast, lung, and prostate. This involve- ment can finally lead to local bone destruction with resulting frac- tures, local bone neoformation, or hypercalcemia. The latter com- plicates the clinical course of 10%-20% of the patients with non-smaIl-cell lung cancer and mammary tumors. Both knowledge of the pathophysiologic mechanisms and treatment of this skeletal involvement have progressed substantially in the last years. One of the very recent therapeutic advances has been the finding that bis- phosphonates, a family of compounds characterized by a P-C-P bond, are effective in alleviating some of these conditions. This volume represents the proceedings of a workshop held on December 4, 1987, in Lucerne, Switzerland, devoted to the use of bisphosphonates in tumoral bone disease. This educational work- shop was organized by the Swiss Group for Clinical Cancer Research (SAKK) to foster international scientific exchange and to clarify experimental and clinical problems in the therapeutic appli- cation of bisphosphonates. Experts from various countries were invited to present and discuss their experimental findings and their preliminary clinical results. This volume summarizes the invited contributions, which will be of major interest to clinical oncolo- gists, surgeons, internists, endocrinologists, and pathologists con- fronted with bone destruction in neoplastic disease. We acknowl- edge gratefully the support of Boehringer Mannheim (Schweiz) AG, Rotkreuz.

A major part of orthopedics is the treatment of musculoskeletal diseases caused by structural disorders and mechanical breakdown of living tissue. Therefore, biomechanical consideration of static structures and dynamic mechanisms is compulsory for both diagnosis and treatment of orthopedic diseases. Previous biomechanical studies have enabled great advances in orthopedic implant technology, such as artificial joint replacement and instrumentation for spinal fusion. Consequently the importance of biomechanics is increasing more and more in daily clinical practice and development. In addition, biomaterial research into mechanical properties and tissue reactions of implant materials is certainly an important area of related study. This book is comprised of 22 papers presented at the International Seminar on Biomechanics in Orthopedics and the 17th Annual Meeting of the Japanese Society for Orthopedic Biomechanics, held in Nagoya in 1990. The volume contains full descriptions of both conventional and updated knowledge of the spine, ligaments, artificial joint replacement in the hip and knee, fracture treatment, and gait analysis, as well as biomaterials. I earnestly hope that this book will be of benefit to readers in daily clinical work and research. To close, I would like to thank profoundly the two coeditors, Prof. S.M. Perren and Mr. T. Hattori, and also a quiet supporter Mrs. J. Buchanan in Davos, for their cooperation in producing this book.

The physical examination of the elbow, wrist, and hand can be a complex topic for professionals with all levels of clinical experience. How can advance concepts be taught in a user friendly, clear format, while still providing necessary information for effective diagnosis and treatment of the elbow, wrist, and hand? Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple by Dr. Randall Culp answers these questions. Written by experts, this easy-to-carry book provides a thorough review of the most common pathologic elbow, wrist, and hand conditions, techniques for diagnosis, as well as the appropriate treatment for each condition. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple contains clear photographic demonstrations, tables, sidebars, and charts throughout its pages, allowing a thorough and concise examination of the elbow, wrist, and hand. A glance at what is covered inside: * Physical Examination * Basics and specific tests of the elbow, wrist, and hand * General Imaging * Basics of general imaging of the elbow, wrist, and hand * Common Conditions * Tendinopathy, arthritis, wounds, soft tissue injuries, and more Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple contains essential information to successfully take a complex subject, and bring it to a level that will be welcomed by all orthopedic residents, attendings, physical therapists, athletic trainers, medical students in training, and other health care providers.

This second edition, completely revised and expanded with a new chapter on lower extremity trauma, presents chapters written by widely recognized authorities in the field of human traumatic injury. The topics covered range from automobile restraint systems to cell and tissue biomechanics, and will interest a variety of scholars and professionals including physicians; biomechanical researchers; mechanical, biomedical and automotive engineers; as well as attorneys and jurists involved in accidental injury cases.

External fixation is now being used widely to maintain fractures, osteo tomies, and arthrodeses in a desired position during consolidation. Whereas external fixation has been readily accepted in European countries, its use has weathered a rather stormy course in North America, especially in the treatment of fractures. Only recently has external fixation found its rightful place on this continent as well. Many different models are on the market today, and the practitioner is faced with a difficult decision in selecting a model. Should he buy a system where the fracture has to be reduced first, or should he work with a device permitting a reduction after insertion of the pins? To enable surgeons to study the different systems, to discuss their advantages and disadvantages, and to permit them to put their hands on these devices and inspect them personally, the Division of Orthopedic Surgery, University of Ottawa organized an applied basic science course in May 1981, External Fixation of Fractures. During this course, all major systems were pre sented to the participants. As happened during the course "Internal Fixation of Fractures" held two years ago, the rigidity of internal fixation was frequently and intensively debated. Whereas the rigidity of internal fixation cannot be altered during the course of healing, the rigidity of external fixation can be changed. In fact, with progression of union, rods of increasing elasticity can be used."

During the past 30 years, the Study Group for the Problems of Osteosyn thesis (AO) has made decisive contributions to the development of osteo synthesis as a surgical method. Through close cooperation among special ists in the fields of orthopedic and general surgery, basis research, metallurgy, and technical engineering, with consistently thorough follow up, it was possible to establish a solid scientific background for osteosyn thesis and to standardize this operative method, not only for the more ob vious applications in fracture treatment, but also in selective orthopedics where hardly any problems relating to bone, such as those with osteoto mies can be solved without surgical stabilization. Besides the objective aim, the AO was additionally stimulated by a spirit of open-minded friendship; each member of the group was recruited according to his pro fessional background and position, his skills, and his talent for improvisa tion. Against this backdrop without even mentioning the schooling program well known throughout the world I should like to add some personal and general comments. This book is written for clinicians, instructing them how to perform osteo synthesis with special reference to plating in all its varieties and in strict accordance with the biomechanical and biological aspects and facts. From this point of view, the chapter on preoperative planning merits par ticular emphasis. Not only is it conductive to optimal surgery, it will also contribute to self-education and may found a school."

Commissioned by the Swiss Federation of Manual Medicine and under the patronage of FIMM (International Federation of Manual Medicine) we conducted an international seminar during the week following the 7th Inter national Congress of FIMM (Zuerich/Switzerland - September 1983). Thirty Manual Medicine experts had come together in the education center of the Cloister Fischingen secluded in the eastern part of Switzerland and away from any city life, to discuss in a week long seminar the status of Man ual Medicine. Working together in the form of several groups, the following points were emphasized: - terminology - diagnostic criteria (are Manual Medicine findings reproducible?) - therapeutic interventions (degree of congruity of treatment plans) The participants demonstrated great enthusiasm and commitment, and so it was possible to have the content of the individual group's discussion com municated to and presented for further scrutiny to all participants during the seminar week. As members of the organizing committee and as the editors of this publica tion, we hope to help establish a more standardized international terminolo gy concerning the field of Manual Medicine. As this clinical trial (investigating the diagnostic reliability and the therapeu tic efficiency of MM) shows, factors such as terminology, diagnostic criteria and therapeutic plans are a prerequisite for multi-center studies.

A half century ago, orthopedic surgeons needed to specialize in only the pathophysiology and treatment of the neuromuscular and skeletal systems in order to treat patients. However, since then, surprising progress has been made in medicine, and through the limitless avenues for research orthopedics is now divided into many subspecialities, with terms such as orthopedic pathology, orthopedic oncology, orthopedic rheumatology, and orthopedic traumatology becoming commonplace. Interdisciplinary studies in this and other related fields are now indispensible. As a result, the half-life of the information accumulating yearly has been estimated at five years. In times such as these, if one stubbornly adheres to treatment alone, progress comparable to that in other fields will not be made. If one opens an orthopedic textbook, it is easy to see that there are still many diseases of undetermined etiology; in the last quarter of a century, there has been no evidence of even one of these diseases' etiology having been resolved internationally. This is a direct result of the ineptitude of basic orthopedic research. Therefore, recently in the United States, Japan and Canada, orthopedic research institutes and associations have been established, and SIROT has been organized internationally. This book contains the manuscripts presented by international and Japanese speakers at the 5th Annual Meeting of the Orthopedic Research Society of the Japanese Orthopedic Association, and the Second Inter national Cherry Blossom Conference of Rheumatology.

Minimally Invasive Surgery in Orthopedics: The Upper Extremity Handbook contains all of the valuable chapters from Section 1 of Scuderi and Tria's 2010 hardcover reference. Newly available in an affordable softcover format, this book covers minimally invasive procedures and techniques for the shoulder, elbow, wrist and other topics applicable to the upper extremity. The book is fully illustrated with more than one hundred pictures and clearly written for ease of understanding. Surgeons, residents, and fellows alike will find this thorough and focused handbook invaluable.

This book is a record of the papers read at the first meeting of the European Society of Knee Surgery and Arthroscopy (ESKA). This was held in the magnificent International Congress Centre (ICC) in West Berlin. Planning for the inaugural meeting of a proposed large society is inevitably fraught with problems and doubts. However, thanks to the tremendous assistance given by the ICC organization and to the participation of so many orthopaedic surgeons from Europe and all over the world the society had a very successful meeting, and it is fitting that the papers are collected together in this book as a permanent record. Various factors combined to delay the appearance of the book until now, shortly before the second ESKA meeting (1986) in Basle. We should like to take this opportunity of thanking Springer-Verlag for all the hard work involved in ensuring that the book was finished before this occasion and while the subject matter is still so topical.

It is with great pleasure and, much interest that I accepted to write the foreword to this book by Paul Doury, Yves Dirheimer, and Serge Pattin on the subject of "algodystrophy." First, because I know the extent of their personal experience, from which they have selected the best for this book. Second, because it seemed to me that their detailed analysis of the numerous works on the subject, works which have been published all over the world and which provide diverse physiopathologic interpretations, would provide a comprehensive study meeting a real need. Algodystrophy, to adopt the term used by the authors, merits rheumatolog ists' careful attention. It is indeed a frequent condition and, as is now well known, occurs in the most varied etiologic circumstances; it is not solely posttraumatic, a notion on which diagnosis had long been based. This variable etiology suggests the complexity of algodystrophy's pathogenic mechanism."

During the past few years, a considerable number of monographs on bone tumors have been published. They are mainly restricted to bone tumors as clinical-pathological entities, since their diagnosis, more than that of other tumors, requires the interdisciplinary cooperation between orthopedic specialist, radiologist, and pathologist. However, investiga tions concerning the histogenesis of bone tumors are rather limited, although they might be helpful in explaining the unique morphological heterogeneity of tumors of the skeletal system. Furthermore, the histo genetic approach in the study of bone tumors may facilitate the inter pretation of the advanced cytobiological methods available for improv ing classification and diagnosis. Therefore, this volume presents recent pathological advances in the biological characterization of bone tumors. A major chapter deals with the differential diagnosis of Ewing's sarcoma as regards its demarcation from the so-called neuroectodermal tumor of bone. The analysis of the ground substances in bone-forming tumors may be helpful for their classification. Therefore the volume includes a chapter on the biochemical and histochemical analysis of different osteosarcoma types. Recently it has become clear that in addition to different collagen types which are not specific for bone tissue, several bone-specific proteins occur, one of which is osteonectin. Its distribu tion is obviously important for the classification and diagnosis of osteo blastic tumors. Proliferative behavior is of major importance for the diagnosis of malignant tumors.

During the last decade the therapeutic approach to musculoskeletal tumors has changed dramatically, from ablative surgery with ampu tation ofthe limb to reconstructive surgery with transplantation of bone and vessels combined with radio-and chemotherapy. This has changed the demands on radiologists and pathologists to a considerable degree. At the same time there has been a manifold increase in the diagnostic possibilities offered by modern radiology, with several new modalities affording a potential for morphologic depiction and tissue character ization that was unattainable a decade ago. Today, the definitive diagnostic work-up and treatment of patients with musculoskeletal tumors is most often done in tumor centers, by groups that ideally should be composed of an orthopedic surgeon, radiotherapist, oncologist, radiologist, pathologist and cytologist. It is necessary for all the members of this team to be well versed in the surgi cal and other treatment principles, in the pathologic concepts, and in the radiologic interpretation of musculoskeletal tumors. Moreover, it is important that the modern diagnostic approach to musculoskeletal tumors is well known also at the referring center, be it a private practi tioner's office or a large hospital. This will avoid unnecessary biopsies, and repetition of radiologic and other diagnostic procedures that have already been performed at the referring center."

"Physiaians have aZways known, though often they are reZuatant to adrrrit it, that the quaZity of their daiZy praatiae depends on the resuZts of researah * . . Irvine H. Page * The 1985 App1ied Basic Science Course distinguished itse1f for three impor- tant reasons. First, it showed c1ear1y the extent to which biotechnology and biomechanics have become an integral part of orthopedics. Second, it emphasized the increasingly important role the orthopedist will have to play in the treatment of the aging population. Projected Canadian statistics estimate that the population aged 65 years and older will in- crease from the current 9. 7% to 13% by the year 2000. Based on the current total population of almost 25 million, the number of hip fractures caused by age-related bone 1055 will almost double and will reach approximately 28,000 per year in Canada. Extrapolation of these figures according to populations in other countries is easy. The costs in expenditures and human suffering are inestimable. This is an area where orthopedic research will have to redouble its efforts in the hope of finding better preventive measures. Furthermore , knowledge of the pathogenetic mechanisms of bone 1055 becomes increasingly important in osteoporosis associated with weightlessness. The third impressive insight we derived from the presentations at this sym- posium was the revelations of the latest imaging techniques and monitoring devices. Nuclear medicine, computer assisted tomography, and nuclear- magnetic resonance are being applied to bone disease.

The management of ankle injuries has long been a stumbling block for orthopae dists in training. As a first year resident, I was fortunate to encounter the series of articles by N. Lauge-Hansen and T. Baek Kristensen that classified ankle injuries according to their mechanism. I found this information quite helpful throughout my residency and early years of practice. Several years ago, an attempt was made to summarize this material for the benefit of the orthopaedic house staff of Thomas Jefferson University. It quickly become obvious that such a "manual" would require a great deal of professional illustration and editorial assistance in order to be effective. Almost simulta neously, a fortuitous encounter with Ms. Marie Low (at that time Medical Editor of Springer-Verlag New York Incorporated) provided both the stimulus and the means to present this information in the manner and detail which it deserved. Contributors were carefully selected for their knowledge and experience in particular areas and for their willingness to cooperate in providing a smooth flowing manuscript. This text contains little new material. Rather, it represents an attempt to bring together, under one cover, the wealth of extant information on this subject. Wherever a consensus could not be perceived, conflicting views have been sum marized as objectively as possible. Unfortunately, there are still many aspects of ankle injury for which we have more questions than answers."

When 1 first developed an interest in the pathology of bone 1 found that there were relatively few books on the subject available. Much of my information had either to be obtained from searching the journals or from senior colleagues in the field, who, 1 should add, were always more than willing to teach me. With this memory in mind, 1 have endeavoured to produce a book which 1 hope is of a convenient size and yet will hold sufficient information to be of use mainly to the pathologist faced with a bone problem. This is not intended to be an all-embracing source of knowledge on the subject; indeed, such a task could not be undertaken by a single author in these days of the rapid increase in information even in small subspecialist areas within bone pathology. Although this book is written mainly for the pathologist, it is hoped that it may also be of interest and value to orthopaedic surgeons, rheumatolog ists and radiologists. Most of the illustrations are original and many of the drawings are my own. There has been a long tradition of interest in bone pathology at The London Hospital, which has resulted in a wealth of material being available to me from the archives of the Department of Morbid Anatomy. A few of the photo graphs are those of Prof. H. Turnbull; the observant reader will detect these, since the scales used are not metric."

Edited by the respected pediatric orthopaedic surgeon Ali Kalamchi, M.D. with contributions from other experts in the field, Congenital Lower Limb Deficiencies is a single source reference guide for rare complex congenital defects of the lower limb. The text is divided into three sections. The first section discusses normal limb development; the genetic, familial, and historical nature of lower limb defects; and the evaluation and categorization of such defects in pediatric patients. The second section characterizes and classifies the congenital defects and covers early long-term planning of patient management based on clinical and radiographic findings. The third section analyzes the treatment modalities, including several chapters on the relationship of sports therapy to the treatment plan. In addition, the authors contribute their wealth of expertise by sharing their experiences and preferences in the treatment of congenital lower limb defects. The team approach for geneticists, pediatricians, orthopedists, therapists, prosthetists and other health care professsionals involved in each case is emphasized.

The widespread occurrence of the various forms of arthritis not only results in a great waste of manpower, but also causes immeasurable pain and suffering for the patients. Due to the limited understanding of its etiology, the currently available treatments are directed at the effects of the disease rather than its causes. The solutions available to the clinician at the advanced stages of arthritis are frequently surgical and include prosthetic replacement arthroplasty. Many advances have been made in the last decade in the basic understanding of the kinematics and kinetics of anatomical joints, as well as in the technology of joint replacement. The NATO Advanced Study Institute held in Portugal during June 20-July 1, 1983 addressed these topics and provided instruction on the advances in biomechanics of diarthrodial joints. The proceedings of this Institute are presented in this volume. Many different areas of specialization contribute to the field of joint biomechanics. Due to the complexity of each individual topic, it was not attempted here to present a complete treatise of each of these areas. Each chapter typically gives a review and a flavor of the subject matter, as well as discussing the state-of the-art advances in general or in specific research areas. Some of the chapters, such as those on lubrication and muscle mechanics, are more mathematically oriented than the others. Nevertheless, the reader with a non-engineering background, I trust, would still find most of the book informative and easy to read."

In orthopaedic surgery, the study of the foot has a special place. Familiarity with the congenital and acquired problems of in- flammation and arthrosis must be blended with an understand- ing of the mechanics of support and propulsion before a sure choice of effective treatment can be made. There is involvement of bones, joints, tendons, ligaments, soft tissues and integument, none of which can be treated in isolation. Superficial appraisal can lead to the cardinal error of facile diagnosis, and ignorance of the physiology of the organ and of the differences of expert opinion with respect to pathogenesis and basic therapeutic con- cepts invites inevitably poor management. In this book, I have attempted to interpret pathology, clinical presentation and treatment in the light of practical experience. I do not presume to be original, for many distinguished authors on the subject already. Lelievre (1952), Viladot et have written al. '1956), de Doncker and Kowalski (1970) and many others, preceded by Hohmann (1951), Morton (1935), Hauser (1950) and Boehler (1944), have all contributed significantly to our ba- sic knowledge and opened the way to understanding. The philosopher Alain wrote succinctly: "When it is fully com- prehended that there is no knowledge without experience and that one cannot conceive an idea unless there already exists a thought, no more need be said".

Cannulated Screw Fixation is the first volume of its kind to provide both the biomechanics of these screw systems as well as complete operative techniques. This book teaches the orthopaedic surgeon and resident all aspects of cannulated screw fixation from principles (biomechanics, design, materials, manufacturing) to clinical uses including anatomy, imaging techniques, advantages, complications and outcomes. This comprehensive text includes chapters written by well-known orthopaedists in their respective anatomical areas with material on preferred operating techniques and uses in more specialized clinical situations for both upper and lower extremities. Edited by pioneers in the development of the cannulated screw this volume is a "must have" for all orthopaedic surgeons and residents.

Bone health is one of the most widely discussed topics in pediatric nutrition. Ensuring adequate calcium and vitamin D intake is essential, and other factors also play a significant role. Bone Health in Children explores the recent decades of research and public commentary on the subject, debunks popular myths, and clarifies the often confusing and contradictory scientific literature. Presenting practical and theoretical education and advice, the book provides rational and accessible information geared to a wide audience of individuals interested in this critical element of pediatric health. Highlights include: The Institute of Medicine process by which Dietary Reference Intakes (DRIs) are developed Iron, calcium, and vitamin D requirements for infants, children, and pregnant and lactating women Controversy over high-dose vitamin D supplementation and pregnancy Detailed explanation of the scientific research process related to human nutrition The nonbone health aspects of vitamin D and why literature claims about this topic can be misleading Frequently Asked Questions regarding nutrition with answers in short format Providing a solid understanding as to how dietary guidelines are developed and evaluating the strengths and weaknesses of their underlying data, this volume answers practical questions crucial for choosing diets for children while also delving into the more theoretical aspects of conducting and interpreting medical research.

No other book covers as extensively all aspects of peripheral nerve surgery. This includes the pathology and pathophysiology of compression neuropathies, traumatic nerve lesions and nerve tumours, and their treatment with various techniques. All body regions are described adequately. The second part of the book deals with palliative surgery for reconstruction of lost function. This includes a comprehensive array of muscle and tendon transfers, functional muscle transplantation and intramuscular neurotisation.

Methyl methacrylate (MMA) is the basic component of bone cements. To use it, a dough is prepared from the liquid and powder by mixing right before application, which is normally done by the operating team. During its working phase the dough is then inserted into the tissue where polymerization is completed. Thus, the final implant polymethyl methacrylate (PMMA) is only created at the implantation site. Besides methyl methacrylate, bone cements sometimes contain other methacrylates, such as butyl methacrylate. To achieve X-ray opacity, radiopacifiers (zirconium dioxide or barium sulfate) are added to the powder. Both the liquid and powder components contain additives (initiator and activator) that launch polymerization and control the set ting when mixed together. Moreover, softener and emulsifiers are some times used. The addition of antibiotics to the powder component in order to prevent or treat infections has become especially important. Commercial bone cements differ in composition and the course of curing. Some are designed for high and others for low viscosity. The way the user handles and applies the cement always crucially influences the quality of the implant. This is why clear and comprehensive information about the cements should be available to show the user how all the relevant factors work It should also be possible together and how they depend on each other."

The importance of osteoporosis in the United Kingdom as a cause of death and disability is now well recognised. There are in excess of 200,000 osteoporotic-related fractures in the UK per annum asso ciated with an estimated cost of GBP942,000,000. Following hip fracture it is known that about 50% of patients are unable to live indepen dently and about 20% of such patients die within the first 6 months. These figures, compelling as they are, reflect poorly on current medical practices which manifestly have failed to identify patients with low bone density at risk of fracture. The hope is that the techni cal advances which have enabled bone mineral density, and other allied indices, to be measured with high precision and accuracy offers the chance of identifying patients at risk of fracture and guiding the clinician to make treatment decisions which may reduce the patients' risk of fracture. In the UK, services for identifying patients at risk of fracture are still in their infancy and are not uniformly available throughout the country. This situation is, however, likely to improve particularly fol lowing the publication of the Royal College of Physicians report "Osteoporosis -clinical guidelines for prevention and treatment" and the recognition in "Our Healthier Nation" that osteoporosis pre vention should be included as a target to achieve a reduction of 20% in accidents by 2010.